Management of Acute Epiglottitis in Adult Populations

Acute epiglottitis in adults is characterised by rapid inflammation of the epiglottis and surrounding supraglottic tissues, posing a significant risk of airway obstruction. Presenting symptoms commonly include severe sore throat, odynophagia, drooling and, in more advanced cases, stridor and respiratory distress. Early recognition relies on a high index of suspicion and may be aided by lateral neck radiography or fibreoptic laryngoscopy when facilities permit. Initial management prioritises airway assessment and the prompt institution of supportive measures, including humidified oxygen and intravenous corticosteroids to reduce mucosal oedema. Empirical broad-spectrum antibiotics targeting common pathogens such as Haemophilus influenzae, Streptococcus and Staphylococcus species are recommended, with adjustments guided by culture results when available. Decisions regarding airway intervention hinge on the degree of respiratory compromise; elective orotracheal intubation under controlled conditions is favoured when airway patency is threatened, whereas surgical tracheotomy may be reserved for situations where intubation is judged high risk or has failed. Multidisciplinary collaboration between emergency medicine, anaesthesia, otolaryngology and intensive care teams underpins successful outcomes. Advances in early airway imaging, antibiotic stewardship and peri-operative protocols have steadily improved morbidity and mortality profiles, yet variations in practice persist internationally. Awareness of comorbid risk factors—such as diabetes mellitus, smoking and immunocompromise—guides risk stratification and informs the intensity of monitoring and intervention. Overall, management algorithms continue to evolve, emphasising timely diagnosis, judicious use of airway techniques and a coordinated team-based approach to prevent hypoxic complications and ensure rapid recovery.

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Management of Acute Epiglottitis in Adult Populations publication trend

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Technical terms

Epiglottitis: Acute inflammation and swelling of the epiglottis and adjacent supraglottic structures that may compromise the airway.

Intubation: Placement of an endotracheal tube through the vocal cords to secure and maintain airway patency.

Tracheotomy: Surgical creation of a stoma in the trachea to bypass upper airway obstruction and facilitate ventilation.

Stridor: High-pitched inspiratory sound resulting from turbulent airflow through a narrowed upper airway.

Supraglottitis: Inflammation of the epiglottis and surrounding tissues above the vocal cords, often used interchangeably with epiglottitis in adult contexts.

References

1. A Retrospective Cohort Study of Acute Epiglottitis in Adults. Western Journal of Emergency Medicine (2021).
2. Comparison of intubation and tracheotomy in adult patients with acute epiglottitis or supraglottitis. European Archives of Oto-Rhino-Laryngology (2019).
3. Acute adult supraglottitis: Difficult intubation & potential airway loss. Trends in Anaesthesia and Critical Care (2023).